A hypnoanalytic investigation of psychogenic dyspnea with the use of induced auditory hallucinations and special additional hypnotic techniques

This paper describes in detail and with discussion the hypnoanalytic session which was instrumental in relieving a patient of severe dyspnea and fatigue based on intense, long standing psychological conflict. The conflict entailed the intermingling of past concerns and current pressing problems.

These had to do with the patient's long repressed feelings about having been told that her birth had been unplanned. They related to current in decision about becoming pregnant. Attitudes toward her parents were sig nificant and these involved mixed feelings with the significance of hei conscious and unconscious images of them. Into this picture there wen projected the patient's attitudes toward herself and her methods of functioning somatically as well as psychologically. The symbolic connotation of her symptoms as deterioration and dying in relation to needs for self destruction were clarified. The symptoms of one and a half to two yean duration were dissipated within a few hours and improvement had been maintained for more than a year at the time of writing.

The use of induced music associations in order to make inroads into the core of the conflict is described. The dynamic significance of spontaneous choice of such theme is discussed. Other hypnotic techniques involve visual imagery with dream-like qualities and in the form of scene visualizations (8, 9). Attention is centered on induced auditory hallucinations and interesting facets of such experiences are discussed in relation to subjective and objective qualities of such hallucinations and the issue of dynamic validity.     

The psychotelerapeutic use of hypnosis: Case illustrations of direct hypnotherapy

Direct hypnotherapy is described for alleviation of anxiety, removal of symptoms, and alteration of behavior patterns and at titudes. It may incorporate persuasion and reassurance. The hypnotherapist using direct hypnotherapy undoubtedly conceptualizes his techniques in some measure and within some theoreticd frame of reference. This adaptability is a signpificant advantage for hypnotherapy. Any suggestions offered to patients serve a9 stimuli that set unconscious forces in motion within each patient. These forces are reorganized and lead, when favorable results ensue, to more efficient, symptom-free patterns. The doctor-patient relationship influences the therapeutic process and progress, and hypnosis has conscious and unconscious meanings for both patient and therapist which are implicit in the facets of interaction. Forces within patients strive toward healthy change and some tend also to resist change. The patients described here were troubled by severe anxiety, ichthyosis, gastrointestinal discomfort, achalasia of the esophagus, Gaes de la Tourette's disease, chest pain, vaginal spasm, spastic colon, and sexual impotence. Degrees of succesa and failure are mentioned within the framework of concepts such as assurance of illness reversibility, authority substitution, suggestibility in relation to symptom relief, and symptom substitution.     

Washington medical update

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Practice Pearl

This article demonstrates the safety and effi cacy of the nutritional supplements glucosamine and chondroitin sulfate used in combination in the management of osteoarthritis.     

Location of Cardiac Arrests in the Public Access Defibrillation Trial

Background. The Public Access Defibrillation (PAD) Trial found an overall doubling in the number of out-of-hospital cardiac arrest (CA) survivors when a lay responder team was equipped with an automated external defibrillator (AED), compared with cardiopulmonary resuscitation (CPR) alone. Objectives. To describe the types of facilities that participated in the trial andto report the incidence of CA andsurvival in these different types of facilities. Methods. In this post-hoc analysis of PAD Trial data, the physical characteristics of the participating facilities andthe numbers of presumed CAs, treatable CAs, andsurvivors are reported for each category of facilities. Results. There were 625 presumed CAs at 1,260 participating facilities. Just under half (n = 291) of the presumed CAs were classified as treatable CAs. Treatable CAs occurred at a rate of 2.9 per 1,000 person-years of exposure; rates were highest in fitness centers (5.1) andgolf courses (4.8) andlowest in office complexes (0.7) andhotels (0.7). Survival from treatable CA was highest in recreational complexes (0.5), public transportation sites (0.4), andfitness centers (0.4) andlowest in office complexes (0.1) andresidential facilities (0.0). Conclusions. During the PAD Trial, the exposure-adjusted rate of treatable CA was highest in fitness centers andgolf courses, but the incidence per facility was low to moderate. Survival from treatable cardiac arrest was highest in recreational complexes, public transportation facilities, andfitness centers.